European Journal of Case Reports in Internal Medicine <p><strong>The&nbsp;<span class="HPblu">European Journal of Case Reports in Internal Medicine</span>&nbsp;</strong>is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from&nbsp;<a href="">33 European countries</a>.&nbsp;<br><br>The journal’s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field.&nbsp;<strong><br><span class="HPblu">EJCRIM&nbsp;</span></strong>welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight, contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors).&nbsp;<strong><br></strong>The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.<br><br> <strong>EJCRIM</strong> is peer-reviewed with single-blind review and freely accessible to all.</p> SMC media s.r.l. - Via Giovenale 7, Milan - Italy en-US European Journal of Case Reports in Internal Medicine 2284-2594 <h3>Copyright and Disclosures</h3> <p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br> If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary Permission to Reproduce Published Material" forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional "Authorization to Publish" form is required from each corresponding copyright owner.</p> <h3>Copyright Transfer Declaration</h3> <p>(this may be included as a word document with your manuscript submission)<br> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br> I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br>The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/documents/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href=""></a></p> Two sites - one major problem <p>The authors present the case of a 36-year-old woman with disseminated tuberculosis evidenced by pulmonary nodules and urogenital involvement. Diagnosis was confirmed through positive culture for <em>Mycobaterium tuberculosis</em>in urine and bronchial secretions. After&nbsp; 3&nbsp; months&nbsp; of&nbsp; multidrug treatment there was&nbsp; clinical and radiologic improvement.</p> <p>This case highlights that an uncommon case of an immunocompetent patient with disseminated.</p> <p>A delay in the diagnosis of pulmonary tuberculosis can result in serious public health problems with disease spread.</p> Carina Rolo Silvestre André Nunes Ricardo Cordeiro João Eusébio Teresa Falcão António Domingos Copyright (c) Uterine leiomyoma as a cause small bowel obstruction! <p>Small bowel obstruction (SBO) account for a good number of acute surgical admissions; recent developments in both imaging modalities and minimally invasive techniques have lead to better identification of the cause as well as the selection of patients requiring surgical intervention. It is still essential that rare cases are identified and presented to achieve better outcomes.</p> <p>&nbsp;</p> <p>Mechanical causes of small bowel obstruction are not uncommon; we are presenting a rare cause of mechanical bowel obstruction caused by a huge uterine fibroid in a 45 years old lady.</p> Sherif Monib Priyanka Chadha Gary Cross Jamal Zuberi Copyright (c) Persisting SARS-CoV-2 infection in an immunosuppressed medical resident. A case report. <p>&nbsp;</p> <p>Little is known about the behavior of SARS-CoV-2 infection in special populations such as immunosuppressed patients. A 27-year-old medical resident that received Rituximab for anti-NMDA receptor encephalitis, presented to the emergency department with cough and respiratory distress due to SARS-CoV-2 infection. Pulmonary function deteriorated so endotracheal intubation and mechanical ventilation support were necessary. Her symptoms simulated secondary bacterial infection but, SARS-CoV-2 RNA detection by PCR in bronchoalveolar lavage and clinical evolution confirmed otherwise. She was treated as a persistent coronavirus infection due to immunosuppressive agents.</p> Marco Antonio Baez-Garcia José J. Zaragoza Monica Grecia Cadena-Loces Copyright (c) Modified BLUE Protocol Ultrasonography can diagnose thrombotic manifestations of COVID-19 with Normal lung Ultrasound <p>Acute Dyspnoea is one of the most distressing complains for the patients and challenging diagnosis for the physicians. In many cases Physical examination and chest x ray alone not helpful in diagnosis. Lung ultrasonography is becoming a standard tool in critical care medicine. Blue Protocol of ultrasound lung is very beneficial, easy to be applied and help to save time that can be consumed in doing sophisticated investigations like Computerized tomography examination of the chest. Anterior lung sliding is checked first . Its presence exclude pneumothorax. The B profile (Anterior bilateral B-lines associated with lung sliding) suggests pulmonary oedema.</p> <p>The A profile (Anterior bilateral A-lines associated with lung sliding) prompts a search for venous thrombosis. The presence of lung A profile plus Venous thrombosis, Make pulmonary Embolism as a cause of acute dyspnoea on the top of the diagnosis list.</p> <p>Extending the Blue protocol of lung ultrasound by adding Focused cardiac ultrasound (FECHO) can confirm diagnosis of pulmonary embolism in this situation especially in the presence of acute right ventricular strain pattern, pulmonary hypertension and positive McConnell’s sign.</p> <p>&nbsp;In the current Coronavirus disease 2019 (COVID-19) pandemic, A lot of atypical presentations especially thrombotic manifestations is there. We present a case of acute dyspnoea with history of fever diagnosed by Blue protocol ultrasonography plus FOCUS as a case of lower limb thrombosis and acute pulmonary Embolism with no ultrasonographic evidence of lung parenchymal affection.</p> <p>With the help of modified BLUE protocol, we diagnose DVT and massive pulmonary Embolism as manifestation of COVID-19, which was confirmed later with positive nasopharyngeal swab.</p> tamer mohamed Zaalouk Copyright (c) PLEUROPARENCHYMAL FIBROELASTOSIS SECONDARY TO CROHN’S DISEASE – A NEW ETIOLOGY? <p>Pleuroparenchymal fibroelastosis (PPFE) is a relatively rare interstitial lung disease (ILD) consisting of elastofibrosis involving the subpleural parenchyma and visceral pleura with an upper lobe predominance.&nbsp;It can be idiopathic or associated with some forms of autoimmune disease.</p> <p>The authors present the case of a 78-year-old woman with previous diagnosis of Crohn’s disease. She presented a protracted respiratory infection (albeit with no significant history of previous infections), andunderwent a high-resolution chest computerized tomography that eventually showed alterations compatible with PPFE. After excluding other possible underlying causes, a possible link to CD was considered. The follow-up at 12 months showed clinical and radiological stability and also stable lung function under treatment with hydroxychloroquine and prednisolone.</p> <p>This is the first report of PPFE in the context of Crohn’s disease. Further studies will be important to further investigate this pathological association and its prognostic implication<strong>.</strong></p> Carolina Amado Pedro Gonçalo Ferreira Copyright (c) Inflammatory bowel disease storm: case report <p>Inflammatory bowel disease (IBD) with it is two variants ulcerative colitis and Crohn’s disease are recognized causes of gastrointestinal diseases affecting around 2.2 million of European population and 1.5 million Americans.</p> <p>The incidence of IBD in Saudi Arabia is 6.72 cases per 100,000 persons.</p> <p>Thromboembolism (TE) is known to be one of the extraintestinal complication of IBD affecting around 0.7 to 7.7 % of the patients 4 and usually it occurs as long-term sequel in association with disease activity.</p> <p>A rare form known as “thrombotic storm could be the initial presentation of the patients.</p> Abdulrahman Nasiri Mohammed Alkathami Copyright (c) Cryptococcal necrotizing pneumonia with ARDS in a non-HIV patient <p>We report the first description of an association between cryptococcal pneumonia and severe ARDS. A twenty years old woman treated in hematology for a T/NK lymphoma was admitted in intensive care unit for acute respiratory distress syndrome. After initial improvement, a CT scan performed after secondary deterioration revealed a necrotizing pneumonia. A bronchoaspirate was positive for <em>Cryptococcus neoformans </em>var <em>neoformans</em>. Despite specific treatment, hypoxemia worsened requiring vv ECMO. The patient died one month later <strong>with necrotizing Cryptococcus pneumonia complicated with refractory ARDS, without other etiology of pneumonia</strong><strong>.</strong></p> Nolan Hassold Vincent Ioos Daniel Da Silva Laurent Lainé Copyright (c) ENCEPHALOPATHY AFTER BENDAMUSTINE TREATMENT, A RARE SIDE EFFECT? <p>Bendamustine is a chemotherapeutic drug associated with frequent hematologic and gastrointestinal adverse effects and, more rarely, neurological toxicity.</p> <p>We present a case of a 79-year-old man withFollicular Lymphoma, grade 2, Ann-Arbor stage IV-A, FLIPI 4, High Risk, with bulky disease and vital organ compression, treated with R-CHOP and then R- Bendamustine, who developed an encephalopathy roughly 2 months after the last cycle. After ruling out other possible etiologies, we assumed patient’s encephalopathy was due to a delayed bendamustine side effect, possibly aggravated by the concomitant administration of Rituximab.</p> <p>The authors intend to alert for this rare adverse effect, its difficult identification and the need to rule out other etiologies.</p> Carolina Amado Gisela Ferreira Fernando Silva Mariana Silva Leal Margarida Cruz Copyright (c) Unusual location of a recurrent epidermoid cyst <p><strong>Introduction</strong></p> <p>Epidermoid cysts of the temporal bone are rare benign lesions that grow slowly.</p> <p><strong>Patient and Methods</strong></p> <p>We report a case of a 69-year-old female patient followed up for a symptomatic intradiploic epidermoid cyst of the temporal scale and left mastoid region, operated on and recurrent.</p> <p><strong>Results</strong></p> <p>MRI noted a well-limited lesion in T1 hyposignal, T2 hypersignal, FLAIR and diffusion not enhanced by gadolinium, compressive, with bone lysis on CT.</p> <p><strong>Conclusion</strong></p> <p>The epidermoid cysts of the temporal bone are rare benign lesions whose diagnosis is presumed with a lesion of fluid signal except in FLAIR sequence.</p> OUMNIYA ABOUHANINE AICHA MERZEM VIANNEY NDAYISHIMIYE HASNAA BELGADIR OMAR AMRISS NADIA MOUSSALI NAIMA EL BENNA Copyright (c) Subcutaneous abscess secondary to a totally implantable venous access port (TIVAPs) infection <p>A 64-year-old woman with an infiltrative left breast carcinoma presented with fever, pain, redness and swelling in her front right arm where a brachial venous access port is placed. A computerized tomography showed a subcutaneous abscess and the blood, port and subcutaneous abscess cultures were positive for <em>Staphylococcus aureus.</em> The patient was successfully treated with Cloxacilin for 14 days after the abscess was drained.</p> Sonia Morón Losada Cristina Macía-Rodríguez Ana Belén Sanjurjo Rivas Javier de la Fuente Aguado Copyright (c)